PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date:4s"...�...,
Owner:
Address
• ,atlC.o°.�'
Address
:.•
N4(5897 : /'
MPATI 101 f%C B ILDING
No. _ Street ;""_" _ Part t
Lot _ _.{ _ _ __ Block _ _ - .. Addition or Sub -l)" on
Corner Lot -_ _r .. __ Inside Lot"" _ Setback's _ _ S=y--S-
Sewer Elevation _ _ _. _._ Foundation Elevation
DESCRIPTION OF BUILDING
TOAused.
,� Front Depth , Height Sq F't." ir"i` . Cu. Ft.
_t Depth _ _ Height Sq. Ft. Cu. Ft. s
Type of lfonstructlon 9IZZEst. Cost . __ To be Completed _
In consideration of the issuance to me of a permit to construct the building described above, I agree- to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
in consideration of the payment of a fee of $_
permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that theperson to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or .any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violayltozNf any of the provisions of said
ordinances. i I
19F-- Building Inspector
NOTICE:
This permit doss not cover the construction, Installation for wiring,. plumbing, gas heating, sower or water. Be sure to see
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FAIDLEY, MINNESOTA
Owner's Name Builder
Address Address
LOCATION OF BUILDING
/ P
No. Street /, Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot tom' Setback Side -Yard l�
SEWR ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front 73 DepthHeight
Sq. Ft. / Cu. Ft.
Front Depth i Height l
Sq. Ft.� Cu. Ft.
l>�
Type of Construction ,�/1.%r� Estimated Gosh4
To be Completed
The undersigned hereby makes application for permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE - `'Z 6 " 6 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plumbing and Cas Fitting Permit
DepL of Bldgs. Phone SII 4-1
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
OOT��A
Number Fixtures ......................
Zrn
�L,
$�—
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
G
Catch Basin ............................
N
WATER HTR.
GAq
EIEC
�— x
3C3
$ '
�F�
m
y
3F
cLL
NO.
�'c
cpm
<3
U�
$ `°
t90
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
Base
1st
2nd
3rd
—
4th
• Future Connection Openings
Connected withI
Sewer
New Fixture, Old Openings JI
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
OOT��A
Number Fixtures ......................
x $1.50
�L,
$�—
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) .... _..
�— x
2.00
$ '
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
$ `°
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of
Used as
To be compietea aoout
Estimated Cost, $
Old—New. Building Permit No c
.00W
ROUGH 0,– '2 / 6 7 -
FINAL
a 2 2M 7-59
Apphcarion for Power Punts and Heating, Cooling, Ventilation, .Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ..... . .................. 2.00 $
Replacement of Furnace .............................. .§.00 $
Repairs & Alterations—up to $500.00 .... ............ 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
STEAM or uOM-W-ATER SYSTEM
Furnace Shell & Lines—to, 400 sq. ft. EDR Steam....... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ b
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
s ,
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FFtE
$
ROUGH-
OUGH
FINAL-
FINAL
Dept. of Bldgs. Phone SU.
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of
Used as
To be completed =_4z22t'_.`
Estimated Cost, $
Old—New. Building Permit Noy Permit No. a.-?�
DESCRIPTION/OF WORK
HEATING or POWER PLANTS -Mean, Hots WA—ten Warm Air—No
Trade Nam z� Size No '0 P
poo
Capacity Sq. Ft. E.D.$ ®y BTU /P' ' H.P.
Total Connected LoaKind of Fuel
BURNER — Trade Name ° ° Size No
Capacity
Capacity Sq. It. E.D.R BTU H.P.
(REMARKS—OVER)
az 2M 759
+IAT LOSS CALCULATIONS, ,r BURMAN COMPANY
Weatherstrips � Construction No. Insulation
uideWindows ( Doors Reference 'Out. Wall Int. Wad Cuing Roof floor Kind How Applied
Yes—NO Yes�io 19_
/ F1.116, d s;3�, A� Room I Lenirth ®1 ` Width -'2 o Hei$ht f- 11 1 FI_I �� � � - Rnnm I Length o -L.;- Width s 1-p— Heiizht
Windows and Doors—Crachge and Area
T
g�
�f
Width Height No. 04 Lineal ft. Area
No. of pane of pane lights of crack eq, ft
2r , 30 1
Net exp. wall J
0
Int. wall
Floor
Coef.1
Btu
Infiltration
2,
Required sq. ft. E.D.R.,or sq. ins. W.A. Leader area
v o 1
2 -,-Vs o
Glass
1
4"P
;L J? 00
Exp. wall
3
Net exp. wall
17—
/V
-7 0
Int. wall
Floor
I
Ceil.
='
rf
7, v
I otal tstu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
i Fl.l,J)T Room I Lenath // Width V Height
Windows and Doors—Crackage and Area
T
Infiltration
Glass 2, 2..,..J
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
2r , 30 1
Net exp. wall J
0
Int. wall
Floor
Coef..
Btu "
Infiltration
r
Required sq. ft. E.D.R.,or sq. ins. W.A. Leader area
en
ej "
Glass
1
Z C
Exp. wall
3
Net exp. wall
17—
/V
-7 0
Int. wall
Floor
I
Ceil.
%0
/
7, v
I otal 15tu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Zuo
I F1.1 R,, --r, 0 1 Room ILensath J t Width 9 t) HAght
Windows and Doors—Crackage and Area
T
Infiltration
Glass 2, 2..,..J
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
2r , 30 1
Net exp. wall J
0
Int. wall
Floor
Coef.
Btu
Infiltration
f �..�
Required sq. ft. E.D.R.,or sq. ins. W.A. Leader area
,
/ J' 0
Glass
Z2
sr o
! p
Exp. wall 6 r�
J 1
Net exp. wall;
J7 C,
d'
-7 0
Int. wall
Floor
I
Cell.
a9
/
tf
Total Btu. 3 �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors--Crackage and Area
T
Infiltration
Glass 2, 2..,..J
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq: ft.
2r , 30 1
Net exp. wall J
0
Int. wall
Floor
Coef.
Btu
Infiltration'
f �..�
Required sq. ft. E.D.R.,or sq. ins. W.A. Leader area
666
Class
Z2
sr o
! p
Exp. wall / 1,. 4 4-L--
J 1
Net exp. wall
J7 C,
d'
-102 1)
Int. wall
Floor
I
Cell.
Y f
/ (
Total Btu. I /,/ / 6
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
W Room I Lenirth "2 Width � Heiaht
Windows and Doors—Crackage and Area
T
Infiltration
Glass 2, 2..,..J
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Exp. wall ® 7 t 1,S- t�
Net exp. wall J
0
Int. wall
Floor
Coef.
Btu
Infiltsatioaa
f �..�
Required sq. ft. E.D.R.,or sq. ins. W.A. Leader area
666
Glass
` .S C)
Exp. wall
Net exp. will
S
Int. wall
Floor
Ceil.�,
Total Btu. I I ` ? to
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room I Length 1Z., Width ®a Height J
Windows and Doors--Csaekage and Area
Width Height I No. of Lineal ft. Area
No. of pane oramne lights of crack sq. ft.
m
Coef.1
Btu
Infiltration
Glass 2, 2..,..J
6,16
Exp. wall ® 7 t 1,S- t�
Net exp. wall J
0
Int. wall
Floor
Ceil:
Total Btu.
Required sq. ft. E.D.R.,or sq. ins. W.A. Leader area
HEAT LOSS CALCULATIONS w -o
d
BRM N COMPANY
WeatherstripsGJLV
de
3 .5/0 d
--/6
Construction No.
Insulation
Windows
Doors
Reference
' Out. Wall
Int. Wall
Ceiling Roof Floor
Find
How Applied
Yes—No
--Ye—s--Wo—
19_.
3 K, j-4
Exp. wall e a
Net exp. wall
31 Z -
® al Vj oom
I Length Width
L�, Height II
t FI_I - o,, a.,1 Room I Length
t_ i— Width / 2— Height `-
Windows and Doors—Crackage and Area
d
a
Width Height No. of Lineal ft. Area
No. of pane ofpane lights of ,r. k sq. ft.
yy
3 .5/0 d
Exp. wall
Net exp. wall o
Coef.
Btu
Infiltration�
nfiltratloII
Infiltration-72
Infiltration
D O
Glass
Total Btu.
Glass
d -7 6 4)
Exp. wall
3 K, j-4
Exp. wall e a
Net exp. wall
31 Z -
c)
7 6
Int. wall
Floor
Int. wall
-5,4
Ceil.
Int. wall
/6)
776
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
F1.1 L; 1'/ Al fir' Room I Length , k --Width 2 (— Height
Windows and Doors—Crackage and Area
a
a
Width Height No. of Lineal ft. Area
No. of pale of pane lights of crack sq. ft.
�4,
2� 5— eel
3 .5/0 d
Exp. wall
Net exp. wall o
Coef.
Btu
Infiltration
nfiltratloII
Infiltration-72
Infiltration
0
Glass
Total Btu.
Glass
d -7 6 4)
Exp. wall'"00
3 K, j-4
Exp. wall e a
Net cxp. wall
31 Z -
Exp. wall 1
5-j J` 'I -1
Int. wall
Floor
Int. wall
-5,4
Ceil.
Int. wall
Floor
776
Total Btu. I
a7 e/ / : e)
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
® F1.1 !?.. Room I Lenath A f Width /° 0 Height
Windows and Doors—Crackage and Area
a
a
Width Height No. of Lineal ft. Area
No.of pane of pane lights of crack sq. ft.
�4,
2� 5— eel
3 .5/0 d
Exp. wall
Net exp. wall o
Coef.1
Btu
Infiltration
nfiltratloII
Infiltration-72
Infiltration
Cell:
Glass
Total Btu.
Glass
d
Exp. wall
3 K, j-4
Exp. wall e a
Net exp. wall
31 Z -
Exp. wall 1
5-j J` 'I -1
Int. wall
Floor
Int. wall
-5,4
1014? 0 tj 6
Int. wall
Floor
Total Btu. -- _ a
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
a
a
'Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq: ft.
�4,
2� 5— eel
3 .5/0 d
Exp. wall
Net exp. wall o
/ 'ed i) , dt
Coef.
Btu
nfiltratloII
Infiltration-72
Infiltration
Cell:
a°
Total Btu.
Glass
d
r"'
3 K, j-4
Exp. wall e a
n`
31 Z -
Exp. wall 1
5-j J` 'I -1
Net exp. wall
Net exp. wall
Int. wall
-5,4
1014? 0 tj 6
Int. wall
Floor
Ceil.
t!
66
Total Btu. r
Required sq. #t. E.D.R. or sq. ins. W.A. Leader area
A FI_I /.i. Room f Length . / V Width _ 1'' I Height o
Windows and Doors--Crackage and Area
a
Infiltration 0
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Glass .' . Pro I�
� J
Exp. wall
Net exp. wall o
/ 'ed i) , dt
'Int. wall
Coef.
Btu
Infiltration
Cell:
a°
Total Btu.
d
Glass
n`
.i " 6
Exp. wall 1
5-j J` 'I -1
Net exp. wall
-5,4
1014? 0 tj 6
Int. wall
Floor
t!
.,/7
V 2,
Ceil.
Total Btu. I" / 32a
Required sq. ft. E.D.R. or sq. his. W.A. Leader area
Fl.) Room I Length 7 Width - Height
Windows and Doors Crackage and Area
m[Afh I sre1e1• nt.....r Te....I ft e�wa.
I m
Coef.
Btu
Infiltration 0
Glass .' . Pro I�
� J
Exp. wall
Net exp. wall o
/ 'ed i) , dt
'Int. wall
Floor
Cell:
Total Btu.
Required sq. ft. E.D.R., or sq. ins. W.A. Leader area
HEAT LOSS CALCULATIONS ' BURMAN COMPANY
Weatherstrips � Construction No. Insulation
Windows I Doors Reference 'Out. Wall Int. Wali Ceiling- Roof Floor Kind How Applied
Yes—No Yes—No 19
14 11.1 ° Room I Leneth / V Width /V Height Jr II FI -I Rnnm I Lenath Width Heiuht
Windows and Doors-Crackage and Area
d
0
Width Height,. No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft..
4/2—
ov
/'-L—
CMEI
Btu
Infiltration
CoeLl
Coef.
Btu
InfiltrationI
Net exp. wall
Exp. wall
d
(/rj 1
1.360
Glass
Ceil.
Int. wall
/
§'0
X
Exp. wall
Net exp. wall
Total Btu. '
Net exp. wall
Int. wall
2 o
p
! r�
Int. wall
no
Ceil.
Floor77—
,mellol
Cell.
1 otal litu. V,
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
FI -I A, -
1..,i Room I Length >?° Width r Height
Windows and Doors—Crackage and Area
d
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq, ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
> ..l ,..4
9
It e . Z e� --``,
/'-L—
CMEI
Btu
Infiltration
CoeLl
Btu
Infiltration
;
Net exp. wall
Exp. wall
d
Glass
Net exp. wall
Ceil.
Int. wall
Exp. wall P j _y' �,
Floor '° Y. r 'f ,,!"" e_.F
Net exp. wall
Total Btu. '
3 -.
Int. wall
Floor
no
Ceil.
Total 13tu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Lenotth Width whrht
Windows and Doors--Crackage and Area
`� 9t�J1
p j l
`�
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq, ft.
> ..l ,..4
9
It e . Z e� --``,
CMEI
Btu
Infiltration
Glass
Glass 22 1 7
Net exp. wall
Exp. wall
Int. wall
Net exp. wall
Ceil.
Int. wall
Floor '° Y. r 'f ,,!"" e_.F
_ Ceil.
Total Btu. '
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
T
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crank sq: ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Floor
Ceil.
Total Btu.
Required sq. ft E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
T
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. will
Int. wan
Floor.
Ceil.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane ofamne I lights of crack I sq. ft.
I I I —+ C6ef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Floor
Ceil:
Total Btu.
Required sq. ft. E.D.R., or sq. ins. W.A. Leader area
SUBJECT
PE13643
City of Fridley
AT THE TOP OF THE TWINS
PERMIT
BUILDING
NEE EIPT
`L �_____ COMMUNITY DEVELOPMENT DIV.
INSPECTION
r PROTECTIVE SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-560-3450
910-F15
7/14/76
JOB ADDRESS 65 Rice Creek Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
11
1
Edgewater Gardens
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Daivd Cahlande r 65 Rice Creek Way N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Pine Cone Nursery, Coon Rapids
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install retaining wall
9 CHANGE OF USE FROM TO
STIPULATIONS
i
I
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood;
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED ISNOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT 1'I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$1,000
WITH WHETHER SPECIFIE6 HEREIN OR NOT. THE GRANTING OF A PERMIT
.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$7.50
PLAN CHECK FEE
TOTAL FEE
$8.00
SIGNATUREOF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG (NSP
DATE
S !NATU OF OWNER(IP OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAME:_ f ru) I Cc" -J ct• BUILDER: U_
ADDRESS ; L'7 � &-'� (2'V_ 1IC' ADDRESS:
NO:. 6 < STREET:
LOT: 1 \ BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: k SETBACK: SIDEYARD:
6
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
i
Lk -1 • ts) Front: ) 1 o Depth:
9
M
Square Feet: Cubic Feet:
Front: Depth:
Square Feet; Cubic Feet:
Height: •
Height:
Type of Construction: Lt)Lc,J_ loEstimated Cost:
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: 1 , 1,5 7 G SIGNATURE :
(See Reverse Side For Additional Information.)
s
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
y
PLUMBING FIXTURE RATES: NO.
>1
o
a
New Fixtures
a
5.00
U
Future Fixtures
x
d
tr
$
Water
m
Y
0m
Bear Dispenser
$
4.00
$
H
$
5.00
$
NE
p,
w
$
Rain Water Leader
Heater
5.00
$
Hydraulic Valve
$
5.00
$
Sump or Receiving Tank
Yc
5.00
S
Water Treating Appliance
$
7.00
$
Hot water Heater
$
5.00
$ IK -0(J
Gas Range
$
10.00
.•••01111
Gas Dryer
$
R
R
C C
a
O
Uqqi�yq
ZYPe
$
U
$
W
N
U
n w
H
W
U
4 3
�y
O
Elec
A
t�A
i
ql
l7
t7
S
1st
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(•) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
New Fixtures
$
5.00
$
Future Fixtures
$
3.50
$
Old Opening, New Fixture
$
1.50
$
Bear Dispenser
$
4.00
$
Hlow Off Basin
$
5.00
$
Catch Basin
$
5.00
$
Rain Water Leader
$
5.00
$
Hydraulic Valve
$
5.00
$
Sump or Receiving Tank
S
5.00
S
Water Treating Appliance
$
7.00
$
Hot water Heater
$
5.00
$ IK -0(J
Gas Range
$
10.00
$
Gas Dryer
$
10.00
$
Back Flow Preventer Required. . . Yes ( )
No (
)
ZYPe
$
5.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1t of Value of Fixture or Appliance $
State Surcharge $ .SU
Reinspection Fee $
($15.00) TOTAL FEE $I�'--!�'(/
Effective May 1, 1990.
Job Address Cb/� L
Department of Buildings
City of Fridley
Tel. 0571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and oorrect
OWNER
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
/ — ( % ` Z
61-
CG
ESTIMATED COST o A ()
OLD - NEW BUILDING PERMIT NO.
Company
Signed B
Tel. No.
ROUGH INSP.
Date
FINAL INSP. /�-7�
Date _
APPROVAL FOR PERMIT
!1INIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.SO STATE SURCHARGE
9
SUBJEct
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
P E R M 1 T
4 8 1- 3 8
r
• _____ COMMUNITY DEVELOPMENT DIV.
,,: -
r � � PROTECTIVE INSPECTION SEC.
1 . �
CITY HALL FRIDLEV 55432
L J\ 612-571-3450
RECEIPT
7
NUMBER
910-Ft5
11Ev
DATE
10/7/98
PAGE 0:
APPROVED BY
JOB ADDRESS
65 Rice Creek Wa
1 LEGAL
DESCR.
LOT NO.
11
BLOCK
1
TRACT OR -ADDITION,
Edgewater Gardcns
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Paul & Rose Ruikka
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
DAK Construction Services
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Q ADDITION ❑ ALTERATION REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage 35 S Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
ZONING
v
SQ. FT
CU FT
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. '
NO DWLG. UNITS
OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
N
AND OW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND DINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
VALUATION
SURTAX
WITH ETHER SPECIFIED- INOR NOT. THE GRANTING OF A PERMIT
2999
1.50
DOES T PRESUME T GIVE UTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PRO NS OF ANY AHER STA E OR LOC LAW REGULATING CON•
STRUC I N OR THE PE ANC OF CONS AUCTION
$74,.75
Fire S 3.00
PLAN CHECK FEE
TOTAL F
X) (n1-7 Ayl d
bLicen C
.0/ $84 5
SIG TURE OF CONTRA TOR U 4Ep ADEN* i TES
P PE
LIDATE T IS--YO/URS PERMIT
SIGNATURE OF OW NEIL �� WNEP BUILDER �DATE�
BLDG NSP
- nAtE
9
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address: VgXXL. A gzej-- 4��( K KA Tel. #
Contractor: DA4�4 (� �C �� r MN LICENSE #
Address:j�—It'd Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Le t Wid Hkt/Ground
OTHER: —�
Construction Type:
Driveway Curb Cut Width Needed: . + 6 Ft =
DATE: (�° APPLICANT•
L
Sq. Ft.
Sq. Ft.
Sq. Ft.
Estimated Cost: $ '�99 %
(Fee Schedule on Back)
_Fl\x $ _ $
Tel. # -),0 7:4 .1-7
Permit Fee
$ ���%
Fee Schedule on Reverse Side
Fire Surcharge
$ Q6
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /. S-0
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ 6) CD
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ O
STIPULATIONS: